Posts Tagged ‘penile neovascularity’

Thank you Storz Medical and Robert Remington (RemingtonMedical.com) for above image of a shock wave unit used for the treatment of erectile dysfunction; note treatment of both the external (left side of image) and internal aspects of the penis (right side of image)

Shockwaves are acoustic vibrations that carry energy, e.g. the sound waves generated by clapping your hands. Compression and expansion of a medium creates a mechanical force that can be put to practical use. Since the 1980s, urologists have used focused shockwave therapy to pulverize kidney stones, revolutionizing their treatment. A much tamer form of shockwaves–low energy shockwave therapy–is a new treatment for erectile dysfunction. When applied to the penis, shock wave therapy causes cellular micro-trauma and mechanical stress, stimulating the growth of new blood vessels and nerve fibers that ultimately improves penile blood flow and erectile function. The long and the short of it is that the physical energy from shockwaves can be tapped into to cause a benefit that can prove advantageous in the bedroom.

Shockwave therapy–which triggers renewed circulation and induces structural changes that can regenerate and remodel damaged tissues–been used for many medical purposes:

chronic wounds

neuropathy

cardiac disease

plantar fasciitis

tennis elbow

Shockwave Treatment for Erectile Dysfunction

Erection quality is all about pressurized blood filling and remaining in the erectile chambers of the penis. Although erectile dysfunction (E.D.) typically has many underlying causes, some of the key reasons are aging and lifestyle-related changes in penile arterial blood flow as well as alterations in the integrity of penile erectile tissue. Most treatments for E.D. to date—pills, urethral suppositories, injection therapy, and prosthetic implants—do not treat the underlying cause of the problem nor modify the natural history of the disease. Penile shockwave therapy can be considered “revolutionary,” since it is a disease-modification paradigm, ultimately changing the health of the erectile tissues and improving penile blood flow .

Penile shocks stimulate penile circulation via growth of new blood vessels, growth of new nerve fibers (neural regeneration), stem cell activation and cellular proliferation, and protein synthesis. On a molecular level, the cell membrane, mitochondria and endoplasmic reticulum respond the most profoundly to shockwaves. As the cells are mechanically stressed, multiple adaptive pathways triggered, inducing structural changes that are capable of regenerating and remodeling penile tissue.

In research carried out by Dr. Tom Lue, shockwave therapy was used to treat diabetic rats that had the arteries and nerves responsible for erections surgically tied off. Cellular activation, regeneration of erectile tissue (smooth muscle and endothelial cells), and improved penile blood flow and erectile function was clearly demonstrated.

The pilot human study on penile shockwaves for E.D. was performed in 2010 by Yoram Vardi. 20 patients were treated twice weekly for three weeks, with application of shockwaves to five separate sites on the penis. This study showed a meaningful increase in erectile rigidity and durability of erections using the International Index of Erectile Function (IIEF) as a metric with improved overall satisfaction and ability to penetrate. An additional study showed positive short-term effects in men who previously had responded well to oral erectile dysfunction medications. To date, clinical trials have shown both subjective improvement in erectile dysfunction as well as objective increased penile blood flow and erectile rigidity. In a large randomly controlled trial with over 600 subjects, the average improvement in IIEF was a significant 6.4.

Treatment variables include the shockwave energy, number of shocks delivered, the sites treated and duration of the treatment. For E.D., low energy shockwaves that are less focused than those used for kidney stone fragmentation are used. Too little energy has proven ineffective, while too much energy can actually kill cells, resulting in scarring and erectile dysfunction. There seems to be a “sweet spot” in terms of the energy level that will optimize erectile function that is generally about 2-10% of the power of shockwave therapy for kidney stones. A recent study used ten once-weekly treatment sessions. During each session, 600 shocks were applied to the erectile chambers of both the internal and external penis with a total of 6000 shocks applied over the course of the 10-week period. The procedure was found to be well tolerated aside from a slight pricking or vibrating sensation that is perceived during the delivery of the shockwaves.

Bottom Line: Low energy penile shockwave therapy is an exciting new treatment option for men with E.D. Safe and well tolerated, it works by causing mechanical stress and trauma to erectile tissues, stimulating the growth of new blood vessels and nerve fibers and potentially enabling penile tissue to regain the ability for spontaneous erection. It uniquely modifies the disease, unlike most traditional E.D. treatments that function as “Band-Aids.” Further clinical investigation is necessary to determine optimal treatment protocols. It is highly likely that in the near future, low energy penile shockwave therapy will be approved by the FDA for the treatment of E.D.

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area,Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.